Propofol doses differ in total intravenous anaesthesia (TIVA) for cancer and no cancer surgery - observational cohort study.

OBJECTIVE: Propofol (2,6-diisopropylphenol) is a broadly used anaesthetic in total intravenous anaesthesia (TIVA) that might alter course of disease in patients who underwent oncology surgery. High inter-individual variability of the propofol dose needed for the same level of consciousness during surgical tumour removal is influenced by many factors. PATIENTS AND METHODS: This is a retrospective observational cohort study of prospectively collected patients data over 20 month's period. The main endpoint of the study was to compare propofol consumption needed for cancer and no cancer surgical interventions. The secondary endpoints were to find out whether there is a difference in recovery time between the two groups of patients and to reveal potential correlations between propofol consumption and age, duration of anaesthesia, body weight and Charlson co-morbidity index (CCI) in cancer and no cancer surgery. RESULTS: There were 103 patients with cancer (mean age 59.3 yr ± 10.7) and 109 patients operated due to other reasons (mean age 47.6 yr ± 17.52). Female sex predominated in both groups (70.9% in cancer and 67.9% in no cancer patients). They differed regarding CCI, 4.48 (±2.1) in cancer in contrast to 1.49 (±1.83) in no cancer patients, and anaesthesia time, 92.67 minutes ± 46.15 vs. 75.24 ± 37.28, respectively (p = 0.0012). Propofol induction dose did not differ significantly between the two groups (p = 0.193), while total propofol consumption was 85.86 mcg/kgBW/min (± 25.98) in cancer and 95.77 (± 31.48) in no cancer patients (p = 0.01). Propofol consumption negatively correlated with duration of anaesthesia and body weight in cancer group. However, in no cancer patients there was very strong negative association with age, duration of anaesthesia and CCI, and significant but weaker negative association with body weight. The time to awakening did not differ significantly between the groups (p = 0.219). CONCLUSIONS: Propofol dose differed in cancer comparing to no cancer patients under general anaesthesia. There was no need for dose adjustment regarding the age and sex in patients with cancer in contrast to no cancer surgery.

[New views on the physiology of wound healing]. / Novi aspekti fiziologije zarastanja rana.

INTRODUCTION: A great deal of progress has been made in the last few decades in understanding the cellular and biochemical interplay that comprises the normal wound healing response. This response is a complex process involving intricate interactions among a variety of different cell types, structural proteins, growth factors and proteinases. PHASES OF WOUND HEALING: Acute wounds maturate through phases of coagulation, inflammation, matrix synthesis and deposition, angiogenesis, fibroplasia, epithelialization, contraction and remodelling, but three classic phases of wound healing are inflammation, fibroplasia and maturation. DERMAL FIBROPROLIFERATIVE DISORDERS: Two main forms of fibroproliferative disorders are hypertrophic scars and keloids. These disorders are characterized by an overabundance of wound collagen through overproduction of collagen or impaired degradation of collagen. Hypertrophic scars are raised, pruritic and edematous lesions that do not exceed the margins of the original wound (in contrast to keloids). Histologically, these lesions are indistinguishable and are characterized by thick, hyalinized collagen bundles arranged in nodules. The degree of hypertrophic scarring is believed to be related to the duration of time during which the wound is allowed to remain in inflammatory phase of healing. Wound closure tension may also play a role by altering the intracellular cytoskeletion of fibroblasts and increased secretion of TGF-beta and cytokines. CONCLUSION: Healing of chronic cutaneous wounds is still a great problem of modern society--huge costs, impaired quality of life. In the last few decades a great progress was made in understanding the cellular and biochemical interplay.

[Evaluation of cognitive deficits after craniocerebral injury]. / Mogucnosti procene kognitivnog deficita nakon kraniocerebralne traume.

The study included 90 persons, one year after experiencing closed craniocerebral trauma. The purpose was to determine, by neuropsychological and neurophysiological methods, the presence of cognitive deficit as a result of cerebral trauma. It is possible to objectivize the organically conditioned cognitive deficit in case of a significant number of patients, and also, by the application of certain methodology, to grade the intensity of existing changes. When compared with other examined parameters, the presence of cognitive deficit was more often in patients of older ages and in those with more serious craniocerebral trauma. A special attention was made to the sensitivity of the used instruments for the verification of cognitive deficit. Among them, Wisconsin test and the method of cognitive evoked potential P-300 appeared to be the most reliable ones.

[The importance of monitoring and correcting the hydromineral status in general anesthesia in children]. / Znacaj pracenja i korekcije hidromineralnog stanja u opstoj anesteziji dece.

Specific physiological features of the child's organism necessitate a preoperative assessment of hydromineral and acidobasic status and its correction in order to reduce intraoperative complications and accelerate postoperative recovery. The analysis was carried out in children who were operated on in general anesthesia in the period of one year. Their hydromineral and acidobasic status was assessed. On the basis of the clinical picture and laboratory analyses we assessed the dehydration and metabolical changes and made the corrections preoperatively. Given are tables for the compensation of basic physiological liquid and electrolyte quantities, a guide for the assessment and the correction of the dehydration levels and the correction of metabolical changes. We also gave tables for the compensation of liquid during the operation in general anesthesia. In the conclusion we review basic principles in the preparation for an urgent operation in general anesthesia in relation to hydromineral and acidobasic status as well as the administration of liquid during the operation.

[Propofol in general anesthesia in children]. / Propofol u opstoj anesteziji dece.

For a long period of time propofol has been in use for total intravenous anesthesia in adults. In our literature there are no data on the use of propofol in pediatric anesthesia. The aim of the study was to compare effects of propofol for the induction of anesthesia, maintenance and recovery after anesthesia, with barbiturate, that is, inhalation anesthesia during spontaneous breathing. 50 children underwent propofol anesthesia. A control group comprised 50 children who underwent thiopentone and halothane anesthesia. The average propofol dose was 2.38 mg/kg/tt. Monitoring of cardiovascular parameters revealed statistically significant variations in systolic and diastolic pressure in both groups, but a more significant decrease was recorded in the propofol group. The decrease, recorded only during the initiation of anesthesia, stabilized afterwards. Side effects (pain during the initiation, apnea, spontaneous movements) were present in the propofol anesthesia, while in the halothane group they were reduced. In the propofol group period of recovery was short, indicating advantages of this anesthetic in day care centers.

[Indications for use of artificial ventilation and its complications in pediatric surgery]. / Indikacije za primenu vestacke ventilacije i njene komplikacije u decjoj hirurgiji.

Artificial respiration is often indicated in the child surgical patient preoperatively, as well as postoperatively because of the specific features of this age group. The characteristics of the respiratory function which are various in different ages, as well as the preoperative condition of the child and the nature of the surgical procedure and anaesthesia are factors which influence the indications for artificial respiration. Of particular importance is the neonatal period of the child where beside the immaturity of vital functions, and a high metabolism level with small calorie reserves, as well as a large consumption of oxygen, there is the addition of stress due to the surgical procedure and anaesthesia which can seriously endanger respiration. The paper analyzes indications for applying artificial respiration at the Clinic for Child Surgery in Novi Sad during a five-year period. Ways of applying artificial respiration, its parameters, as well as the complications during its use are followed. Artificial respiration was applied in 82 children, 46.34% were newborns operated on because of ileus conditions and 43.90% were larger children treated due to polytrauma. The most frequent complications were in the group of newborns: pneumonia, atelectasis, ductus arteriosus opening, lung bleeding and pneumothorax.

[Anesthesia in children with multiple injuries]. / Anestezija kod politraumatizovane dece.

Fifty polytraumatic children operated in general anaesthesia have been presented. We have given the types of injuries, operations and the reanimation and anaesthesia treatment. 26% of children have been operated immediately because of the clinically visible bleeding signs. At the same time, the reanimation measures have been taken. Other children have been operated after reanimation and diagnostic procedures within the period of 2-6 hours after the admission into the hospital. Most of the children (44%) were given neurolept anaesthesia. The authors emphasize that the transportation of polytraumatic children has not always been adequate.